Provider Demographics
NPI:1770724676
Name:HIGH RISK OBSTETRICAL CONSULTANTS, PLLC
Entity type:Organization
Organization Name:HIGH RISK OBSTETRICAL CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-263-2400
Mailing Address - Street 1:1930 ALCOA HWY STE A435
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1520
Mailing Address - Country:US
Mailing Address - Phone:865-263-2400
Mailing Address - Fax:865-263-2441
Practice Address - Street 1:1930 ALCOA HWY STE A435
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1520
Practice Address - Country:US
Practice Address - Phone:865-263-2400
Practice Address - Fax:865-263-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513354Medicaid
TN1513354Medicaid